MEDICARE: DR. JAMES ALDEN STEWART O.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	4901002712	MI

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	410004219	OTHER	MI	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	900B565790	OTHER	MI	BLUE CROSS/BLUE SHIELD

General Provider Information

NPI Number	:	1912997560
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JAMES ALDEN STEWART O.D.

Provider Business Mailing Address
First Line	:	311 N SAGINAW ST
Second Line	:
City	:	MONTROSE
State	:	MI
Zip	:	48457-9744
Country	:	US
Telephone Number	:	810-639-5755
Fax Number	:

Provider Business Practice Location Address
First Line	:	311 N SAGINAW ST
Second Line	:
City	:	MONTROSE
State	:	MI
Zip	:	48457-9744
Country	:	US
Telephone Number	:	810-639-5755
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/25/2005
Last Update Date	:	05/02/2008

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